tbuckley/cabot-search huggingface dataset:
Abstract 49: The Effects of Vitamin D Supplementation on Subclinical Cardiovascular Disease: Results From the Sturdy Trial
Authors: William Earle, Katharine Rainer, Lawrence J Appel, Edgar R Miller, Erin D Michos, Jennifer Schrack, Amal Wanigatunga, Christine Mitchell, Heather Rebuck, Robert H Christenson, Stephen P Juraschek
Journal: Circulation (2023)

Background: In observational studies, older adults with insufficient or deficient serum vitamin D levels are at higher risk of cardiovascular disease (CVD), but randomized trials have failed to demonstrate reduction in CVD risk from vitamin D supplementation. This is possibly because the doses of vitamin D supplements tested were too low. Objective: To determine if higher doses of vitamin D supplementation lower high sensitivity cardiac troponin level (hs-cTnI) and N-terminal pro b-type natriuretic peptide (NT-proBNP), markers of subclinical CVD. Methods: The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a double-blind, randomized, response-adaptive trial that tested the effects of 4 doses of vitamin D3 supplementation (200, 1000, 2000, and 4000 IU/day) on fall risk in adults aged ≥70 years old with low serum 25-hydroxyvitamin D levels (10-29 ng/ml). Hs-cTnI and NT-proBNP levels were measured at baseline and at 3-, 12- and 24-month follow-up visits. For analysis, participants were divided into low (200 IU/day) and high dose (1000+ IU/day) vitamin D treatment groups. The effects of vitamin D dose on hs-cTnI and NT-proBNP were assessed via mixed effects tobit models. Results: Among 688 participants (mean age of 77 ± 5 years, 44% were women, and 18% were Black), 50.7% were in the high-dose treatment group (1000+ IU/day). Hs-cTnI increased in both the low and high dose groups by 5.1% and 5.8%, respectively; likewise, NT-proBNP increased in both groups by 11.3% and 9.3%, respectively ( Figure). Compared to the low-dose group, high-dose vitamin D treatment did not affect hs-cTnI (1.7 % difference; 95% CI: -5.3, 9.3) or NT-proBNP (-1.8 % difference; 95% CI: -9.3, 6.3). Conclusions: Compared to low dose vitamin D supplementation, a higher dose did not affect markers of subclinical CVD in older adults with low serum vitamin D levels. These findings do not support higher doses of vitamin D as an intervention to reduce the risk of CVD in this population.
Abstract P317: Heterogeneity in Prevalence of Hypertension and Overweight/Obesity Among US-Born and Foreign-Born Latino Subgroups: Evidence From the 2010-2018 National Health Interview Survey
Authors: Sabrina Elias, Abeer Alharthi, Oluwabunmi Ogungbe, Ruth-Alma N Turkson-Ocran, Chitchanok Benjasirisan, Yvonne Commodore-Mensah, Cheryl R Dennison Himmelfarb
Journal: Circulation (2023)

Introduction: Latino individuals account for almost 20% of the U.S. population and are disproportionately affected by cardiovascular disease (CVD) risk factors, such as hypertension and overweight/obesity. They are not monolithic, but diverse in culture, lifestyle, and health exposures that impact their cardiovascular health. Further examination of heterogeneity in CVD risk factors among US-born and foreign-born Latino subgroups is needed to deepen our understanding of the burden of CVD risk in this population. Hypothesis: We hypothesized that there would be significant heterogeneity in the prevalence of hypertension and overweight/obesity among foreign-born Latino individuals as compared to their US-born counterparts. Methods: We examined the prevalence of CVD risk factors using a cross-sectional design, among Latino adults in the 2010-2018 National Health Interview Surveys. Generalized linear models using Poisson distribution were fitted to obtain adjusted odds ratio and risk of self-reported hypertension and overweight/obesity among US-born and foreign-born Latino subgroups. Results: We included 175,761 participants with mean(±sd) age 41 (0.2) years, 50.1% female, 32.4% with less than high school education, 84.5% with ≥10 years of length of US residence, and 72% with health insurance. We observed a statistically significant lower prevalence of hypertension among foreign-born Mexicans (adjusted odds ratio [AOR]: 0.98, 95% confidence interval or [CI]: 0.80 - 0.99) and Puerto Ricans (AOR: 0.75; 95% CI: 0.65 - 0.86) compared to their US-born counterparts. ( Table ) Conclusion: We observed heterogeneity in the prevalence of hypertension when foreign-born and US-born Mexicans and Puerto Ricans are compared. No differences were found for overweight/obesity. Our results highlight the need to evaluate CVD risk differences by nativity status.
Abstract P231: Physical Activity During Adolescence and Adulthood Associated to Risk of Diabetes in Mexican Women
Authors: Claudia F Martinez, Josiemer Mattei, Adrián Cortés, Martin Lajous
Journal: Circulation (2023)

Background: Mexico has declared an epidemiological emergency in the country due to diabetes. Although the benefits of physical activity in middle age are established, the health effects of long-term changes in PA from adolescence to middle age have not been documented. Our aim is to explore the pattern of vigorous physical activity (VPA) in adolescence and adulthood and the risk of DM2 in a cohort of middle-age women. Methods: The Mexican Teacher′s Cohort (MTC) is an ongoing study of 115,307 public school teachers. Every three years participants answered sociodemographic, lifestyle, and medical conditions, including self-reported IPA(hours/wk) for age 15 to18 years, and at the previous year of baseline. Cases of diabetes were identified and validated through electronic health records. We estimated Hazard ratios and IC95% intervals. Based on VPA in adolescence and adulthood respectively, women were classified as: consistently inactive (reference), consistently lower activity, low active in adolescence but increase in adulthood, active in adolescence but reduced in adulthood, and consistently higher. To explore recall bias we performed analyzes stratified by age. Results: in a sample of 69,970 women with 41.6 ± 7.3 years of age at enrolment, we identified 4,564 DM cases from 2006-2008 to 2019. Compared with participants who were consistently inactive in both stages, women who increase activity had a lower risk of DM; HR = 0.86 (95% CI 0.74, 1.01). Compared with the reference category, maintaining higher amounts of VPA was associated with lower diabetes risk HR = 0.85, (95% CI 0.75, 0.96). In stratified analyses by age, we observed the same association even in people who reported physical activity up to 35 years before the reference questionnaire. Conclusions: Maintaining higher VPA levels during adolescence and adulthood and increasing VPA in adulthood were associated with a similar low risk of diabetes.
Abstract P145: The Effect of Exercise Level on Weight Maintenance and Cardiometabolic Risk Factors After Clinically Significant Weight Loss: Results From the Prevail-p Study
Authors: Damon L Swift, Joshua McGee, Emily Grammer, Anna Huff, Nicole Gniewek, Covey Clunan, Briceida Osborne, Corby Martin, Robbie Beyl, Robert Carels, Walter Pories, Joseph A Houmard, Laura Matarese
Journal: Circulation (2023)

Introduction: Clinically significant weight loss is associated with health benefits for overweight and obese adults. Participation in adequate amounts of physical activity is critical for weight maintenance. However, few studies in the literature have evaluated the amount of physical activity needed to promote weight maintenance in a supervised exercise training study with corresponding data on cardiovascular risk factors. Methods: Overweight and obese adults (N=39) completed a 10-week OPTIFAST ® weight loss program with supervised aerobic exercise training with the goal of achieving clinically significant weight loss (≥7%). Participants who met the weight loss goal were randomized to levels of aerobic training consistent with physical activity recommendations (PA-REC) (~550 MET minutes per week) or weight maintenance recommendations (WM-REC) (~970 MET minutes per week) for 18 additional weeks. Weight, body composition, and blood measures (e.g., fasting glucose, insulin, and lipids) were measured at baseline, after weight loss (10 weeks), and at follow-up (28 weeks). Results: Thirty-three of the 39 participants achieved clinically significant weight loss (~85%). There were reductions in weight (-8.8 kg), body fat (-2.1%), visceral fat (-120.4 g), along with other health indicators (systolic blood pressure [-6.8 mmHg], diastolic blood pressure [-5.9 mmHg], HOMA-IR [-2.4] and lipids) after the weight loss phase (all p’s&lt; 0.05). Full data for the weight maintenance phase were available in 21 participants due to the COVID pandemic (PA-REC: 12, WM-REC:9). Larger improvements in cardiorespiratory fitness (as assessed by estimated METs [1.7 vs. 0 METs, p=0.01] and relative VO 2 peak [2.3 vs.0.5 ml/kg/min, p=0.04]) were observed in the WM-REC group compared to the PA-REC group, while changes in waist circumference (-2.4 vs. 0.5 cm, p=0.06), visceral fat (-45.7 vs. 8.2 g, p=0.06), and absolute VO 2 (0.1 vs. 0.2 L/min, p=0.09) approached significance. No significant changes were observed between groups for changes in weight, blood pressure, glucose metabolism, or lipid parameters during the maintenance phase (all ps&gt;0.05). Discussion: Clinically significant weight loss combined with aerobic exercise resulted in improvements in cardiometabolic parameters. Exercise at levels associated with the weight maintenance guidelines resulted in greater improvements in cardiorespiratory fitness and may have the potential to improve measures of central adiposity to a greater extent than the minimum physical activity recommendations following weight loss. Future studies should evaluate the impact of different levels of aerobic exercise after clinically significant weight loss in long term interventions.
Abstract P398: Using Human-Centered Design Methodology to Identify Challenges and Inform the Development of a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy From Diverse Clinician, Patient, and Patient Health Partner Perspectives
Authors: Erin M Spaulding, PhD, RN, Nino I Isakadze, Nancy Molello, Shireen Khoury, Yumin Gao, Lisa Young, Fawzi Zghyer, Zahra Azizi, Michael P Dorsch, Jessica R Golbus, Yvonne Commodore-Mensah, Nisha A Gilotra, Alexander Sandhu, Brahmajee K Nallamothu, Seth S Martin
Journal: Circulation (2023)

Introduction: Despite overwhelming evidence that guideline-directed medical therapies (GDMT) for heart failure (HF) can reduce mortality and improve quality of life, significant gaps in treatment optimization persist. GDMT initiation and up-titration are especially critical for improving patient outcomes post-hospitalization. Objective: Identify challenges encountered post-hospitalization in optimizing GDMT for HF management by engaging key stakeholders in human-centered design (HCD) to guide the development of a digital toolkit to increase HF GDMT optimization. Methods: HCD is used to solve complex problems by soliciting input from stakeholders. We recruited: a) clinicians (physicians and advanced practice providers) who provide care to patients with HF across three health systems, b) patients with HF with Reduced Ejection Fraction (HFrEF, EF &lt; 40%) discharged from the hospital within 30 days of enrollment, and c) patient health partners when available. We conducted separate virtual sessions for clinicians and patients/health partners using semi-structured interview guides to identify challenges, motivators and themes. Results: We enrolled 10 clinicians, 10 patients, and 2 patient health partners. The clinicians had a median age of 37 years (IQR: 35-41) and 12 years (IQR: 14-9) experience caring for patients with HF; 80% (8/10) were women, and 50% (5/10) were physicians. Patients had a median age of 53 years (IQR: 48-64); 40% (4/10) were women, 60% (6/10) were a racial/ethnic minority, and 50% (5/10) were married. Top challenges to HF GDMT optimization (e.g. number of medications) and digital toolkit features identified during the clinician HCD sessions are reported in Figure 1. Conclusions: The clinician and patient/health partner HCD findings will inform the development of the digital toolkit, including a patient-facing smartphone application and clinician dashboard, for HF GDMT optimization. We will also conduct HCD sessions in Brazil to further co-design the digital toolkit for low resource settings.
Abstract P122: Life’s Simple 7 and Psychosocial Health Predict Physical Frailty, Hospital Frailty, and Comprehensive Frailty Index 10 Years Later
Authors: Qi Wang, Dongshan Zhu
Journal: Circulation (2023)

Introduction: Life’s Simple 7 (LS7) is a metric for cardiovascular health (CVH). Evidence has shown that LS7 in late life was linked to late-life physical frailty, while the association of LS7 in midlife with multidimensional frailty indicators in late life remains unclear. In addition, there might be synergistic interactions between cardiovascular health and psychosocial health factors on risk of frailty. Hypothesis: Based on the bio-psycho-social medical model, we hypothesized that midlife LS7 status might be related to late life multidimensional frailty indicators (physical frailty, hospital frailty, and comprehensive frailty index), and psychosocial health (social isolation and loneliness) might interact the association between LS7 and frailty. Methods: We used cohort data from UK Biobank. CVH was measured by LS7. A higher score indicated better CVH. Psychosocial health status was measured by social isolation and loneliness and divided into good or poor. Frailty was assessed using physical Frailty Phenotype (FP), a validated Hospital Frailty Risk Score (HFRS) and a comprehensive Frailty Index (FI). Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) on the association between the LS7 score, psychosocial health, and frailty. The synergistic effects of LS7 and psychosocial health on frailty were also analyzed. All HRs were adjusted for sex, age at last follow-up, race, education level, alcohol drinking, and income. Results: For the association of LS7 with FP and FI, 39,047 individuals who attended baseline and visit 2 were included. After a median follow-up of 9.0 years, FP identified 1,329 (3.4%) people with frailty, and FI identified 5,699 (14.6%) with frailty. For association of LS7 with HFRS, 366,570 people were included. After a median follow-up of 12.0 years, 18,737 (5.1%) people were identified as with hospital frailty. Compared to people with poor LS7 score, those with intermediate (FP:HR=0.64, 0.54-0.77; FI: HR=0.77, 0.69-0.86; HFRS: HR=0.60, 0.58-0.62) and optimal LS7 score (FP: HR=0.31, 0.25-0.39; FI: HR=0.62, 0.55-0.69; HFRS: HR=0.39, 0.37-0.41) were associated with lower risk of frailty. Poor psychosocial health was associated with an increased risk of frailty (FP: 1.87, 1.44-2.43; FI: 1.46, 1.24-1.71; HFRS: 1.53, 1.44-1.62). We observed synergistic effects of LS7 and psychosocial health on frailty. People who had good psychosocial status and optimal LS7 score had the lowest risk of frailty (FP: 0.30, 0.24-0.38; FI: 0.63, 0.56-0.70; HFRS: 0.38, 0.36-0.41). Conclusions: Higher LS7 score or good psychosocial health in midlife was associated with reduced risk of physical frailty, hospital frailty, and overall frailty. Psychosocial status interacted with LS7 on frailty. Individuals who had good psychosocial health and optimal LS7 score were associated with the lowest risk of frailty.
Abstract P608: Dynamic Changes in Dietary Guidelines Adherence and Its Association With All-Cause Mortality Among Middle-Aged Chinese: A Longitudinal Study From the China Health and Nutrition Survey
Authors: Xiao Zhang, Xiaona Na, Yanfang Wang, Du Shufa, Ai Zhao, Wannian Liang
Journal: Circulation (2023)

Background: The traditional approach to evaluating dietary quality is based on the achievement of the recommended intakes for each food group, which may overlook the achievement of correct relative proportions between food groups. We propose a “Dietary Adherence Score (DAS)” to assess the degree of similarity between subjects' diets and those recommended in the Chinese Dietary Guidelines (CDG). Furthermore, it is important to incorporate the time-dependent nature of dietary quality into the mortality prediction. Aim: To investigate the association between long-term changes in adherence to the CDG and all-cause mortality. Method: The study included 4533 participants aged 30-60 from the China Health and Nutrition Survey study with a median follow-up of 6.9 years. Intakes from 10 food groups were collected in 5 survey rounds from 2004 to 2015. We calculated the Euclidean distance between the intake of each food and the CDG-recommended intake, and then summed all the foods as DAS. Mortality was assessed in 2015. The latent class trajectory modeling was used to identify 3 classes of participants with distinct longitudinal trajectories of DAS during the follow-up period. The Cox proportional hazard model was used to assess the risk of all-cause mortality in the 3 classes of people. Risk factors for death and a traditional measure of diet quality, the Alternative Healthy Eating Index (AHEI), were adjusted in the models. Result: There were 187 deaths overall. Participants in the first class identified had consistently low and decreasing DAS levels (coefficient= -0.020) over their lifetime, compared with a hazard ratio (HR) of 4.4 (95% confidence interval [CI]: 1.5, 12.7) for participants with consistently high and increasing DAS levels (coefficient= 0.008). Those with moderate DAS had an HR of 3.0 (95% CI: 1.1, 8.4). The effect of DAS was independent of AHEI. Conclusion: People with consistently high adherence to CDG-recommended dietary patterns had a significantly lower mortality risk. DAS is a promising method to assess diet quality.
Abstract P241: Later Menarche Onset Portends Lower Risk of Preterm Birth: Results From the Boston Birth Cohort
Authors: Yingan Chen, Guoying Wang, Xiumei Hong, Mingyu Zhang, Xiaobin Wang, Noel T Mueller
Journal: Circulation (2023)

Introduction: Age at menarche onset reflects many health aspects in women. Later age at menarche has been associated with lower risk of several cardiometabolic disease outcomes, including diabetes and various cardiovascular diseases. However, no studies have reported the association of maternal menarche age with risk of preterm birth (PTB)—a pregnancy outcome with significant racial disparities and cardiometabolic etiology. Hypothesis: Later age at menarche onset is associated with lower risk of PTB. Methods: We conducted a case-control study in the Boston Birth Cohort, including 2242 mothers with PTB [gestational age (GA) &lt;37 wks], and 6022 mothers with term birth (GA ≥37 wks). We used a maternal postpartum questionnaire (administered 24-72 hrs after delivery) to collect data on age at menarche, sociodemographic and lifestyle factors. We used medical records to ascertain GA. We used multivariable-adjusted logistic regression models and restricted cubic splines to examine the association between age at menarche and odds of PTB. Results: Of the 8264 mothers in our study, 46.9% identified as Black and 28.8% as Hispanic. Maternal age at delivery was 28.1y ±6.5y and age at menarche was 12.85y ±1.86y. Our multivariable-adjusted cubic spline suggested a linear dose-response association of age at menarche with odds of PTB and GA (Figure). Per 1-year later menarche onset of menarche was associated with 5% (95% CI: 2%-8%) lower odds of PTB, after adjustment for maternal place of birth, education, smoking status, Mediterranean diet score, and pre-pregnancy BMI. We found a similar pattern (5% lower odds per 1-year later, 95% CI: 1%-8%) in Black mothers. Conclusion: In a large cohort of racially and ethnically diverse women, later age at menarche is associated with lower risk for PTB. Our findings suggests that the origins of higher risk for PTB start early in life, before puberty, and appear to be independent of adiposity. Future studies are needed to identify mechanisms and points of intervention.
Abstract P238: Gait Characteristics in Older Adults Using the Protokinetics Zeno Walkway: The Atherosclerosis Risk in Communities Study
Authors: Laura Skow, B Gwen Windham, A R Sharrett, Michael Griswold, Jennifer Schrack
Journal: Circulation (2023)

Introduction: Slowed gait speed in older adults is associated higher vascular disease burden, greater risk of dementia, and falls. Gait mat measurement technology captures speed as well as additional gait parameters, with potential importance for better risk prediction and identification in older adults, but normative data are needed. We assessed correlations between mat-measured gait speed and gait parameters to identify potential targets for future gait research. We hypothesized that gait parameters would not correlate with overall mat-measured gait speed as strongly as overall gait speed correlates within repeat trials of mat or stopwatch-measured trials. Methods: Participants (n = 402, mean age: 81 years, 54% women, 19% Black race) from the Atherosclerosis Risk in Communities Study completed two consecutive usual pace walks on Zeno Walkway™ gait mats at visit 8. Two-hundred thirty-six participants additionally completed two 4-meter usual pace walks timed by stopwatch. We assessed validity using the difference between the faster of two trials each for mat- and stopwatch-measured gait speed using Bland-Altman plots, and Pearson’s correlations, and examined reliability with consecutive trials within measurement type. We reported mean, standard deviation, range, and correlation of 37 gait parameters with gait speed, as well as intra-person variability (coefficient of variation) and parameter asymmetry between footfalls. Results: Participants had an average gait speed of 0.92 m/sec (SD 0.19 m/sec) measured by mat and 0.99 m/sec (SD 0.21 m/sec) by stopwatch. Mat-measured gait speed was strongly correlated with stopwatch measured speed (Pearson’s Correlation 0.85). Mat-measured walks were on average 0.08 m/sec faster than paired stopwatch-measured walks (standard deviation of difference 0.11 m/sec, p&lt;0.001), regardless of gait speed. Consecutive mat walks had higher Pearson’s and R-squared correlations (0.95 and 0.90) than consecutive stopwatch walks (0.89 and 0.83). Of 37 gait parameters tested, 9 were positively correlated (Pearson’s correlations 0.64 to 0.76) and 7 were negatively correlated (Pearson’s correlations -0.64 to -0.42) with gait speed. Parameter variability in single stance center of pressure distance and gait speed was moderately negatively correlated (Pearson’s correlation -0.50). Correlations between gait speed and gait parameter asymmetry were low (&lt;|0.33|). Conclusions: Gait mat technology shows high reliability and high correlation with stop-watch measurement in older adults in the ARIC population. Additional gait parameters were largely not strongly correlated with gait speed, including step-to-step measures of variability and asymmetry, suggesting avenues for future research to evaluate gait differences more granularly as more sensitive indicators of health risk in older adults.